The ultimate goal of this project is to prepare a comprehensive plan for implementing an integrated medical liability and patient safety program for major health systems in the Seattle-Tacoma metropolitan area of Washington State, to be used in lieu of the current tort system. The new medical liability program will be based on identification of the occurrence of Avoidable Classes of Events (ACEs), an apology and immediate, standardized compensation to the patient (and family, as appropriate) when possible, and several related ancillary support processes. This program will be used to quickly identify errors and make early offers of compensation, increasing the number of patients who are compensated. A focused patient safety training program targeting reduction of these same ACEs will be developed and pilot tested as part of the planning grant. The planning grant will be conducted by a consortium of the leading regional health systems, headed by Multicare Health System of Tacoma, Washington. Other health system grant participants include Swedish Health Services of Seattle and Virginia Mason Medical Center, also of Seattle. In addition to these three large direct health care delivery systems, other participants in the collaborative planning grant project are the Washington Healthcare Forum, the Washington State Medical Association, the Washington State Hospital Association, several major health insurers, and First Choice Health, the state's largest preferred provider organization. To complete the plan, the consortium will first convene an expert panel of local medical liability practitioners, patient safety leaders, and national experts to select a broad set of preventable of medical events that will form the core of the ACEs program. Standard compensation schedules will then be developed for these ACEs, with payment amounts stratified by severity and expected duration of the impact. A case-by-case compensation determination program will be developed to cover all other preventable medical liability cases. Other components of the comprehensive program will include establishing an arbitration or mediation process for alternative dispute resolution, testing patient participation processes through focus groups, adopting an established provider apology process, and pilot testing the linked, focused patient safety program at area hospitals. PUBLIC HEALTH RELEVANCE: The relevance of the proposed project is to fully explore and flesh-out a comprehensive alternative to the current litigation-based tort system approach to resolving medical liability cases - by creating an evidence-based, reasonable compensation system for preventable adverse medical events, linked to hospital and physician patient safety training programs focused on these preventable events. The planning grant will create this system, the implementation of which will begin the process of transforming the current medical liability environment to one in which providers are specifically trained on avoiding adverse events, immediately acknowledge those errors which do occur, and rapidly apologize and fairly compensate the injured patient. This outcome will not only improve patient safety and satisfaction but also can, over time, reduce the costs of care.